MOH GP Competitive Appointment Exam cheat sheet

Wells score for DVT: ≥2 points indicates likely DVT; proximal leg swelling, entire leg swelling, localized tenderness along deep veins, calf swelling >3 cm, pitting edema, collateral superficial veins, previous DVT, active cancer, immobilization, recent surgery.

Centor/McIsaac criteria for streptococcal pharyngitis: tonsillar exudate, tender anterior cervical nodes, fever, absence of cough; each scores 1 point (age modifies score); score ≥3 suggests testing/treatment.

Ottawa ankle rules: obtain X-ray if pain in malleolar zone and bone tenderness at posterior edge or tip of lateral malleolus, or medial malleolus, or inability to bear weight both immediately and in ED.

Acute asthma severity: peak flow <33% predicted = life-threatening; 33-50% = severe; inability to complete sentences, silent chest, cyanosis, bradycardia, exhaustion are life-threatening signs.

Community-acquired pneumonia severity (CURB-65): confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure systolic <90 or diastolic ≤60, age ≥65; each 1 point; score ≥2 consider hospital admission.

Hypertension diagnostic threshold (clinic): ≥140/90 mmHg on two occasions; home/ambulatory monitoring threshold ≥135/85 mmHg; initiate treatment with lifestyle and medications based on risk.

Acute gout: NSAIDs, colchicine, or corticosteroids; do not start or stop urate-lowering therapy during acute attack; target serum urate <360 µmol/L (<300 µmol/L if tophi).

Sore throat red flags: drooling, stridor, trismus, muffled voice, unilateral swelling suggesting peritonsillar abscess or epiglottitis - urgent referral.

Low back pain red flags: age >50 with new pain, trauma, fever, weight loss, night pain, neurological deficits, bowel/bladder dysfunction, saddle anesthesia - urgent imaging/referral.

Type 2 diabetes HbA1c target: <7% for most adults; <8% for elderly or comorbid; <6.5% may be appropriate if achievable without hypoglycemia.

Diabetic retinopathy screening: annual dilated eye exam; if no retinopathy for 2 consecutive years, consider less frequent screening; pregnancy may worsen retinopathy.

Lipid targets for high-risk patients (e.g., established CVD): LDL-C <1.8 mmol/L (or ≥50% reduction from baseline); for very high risk, <1.4 mmol/L.

Singapore cancer screening: cervical (Pap) every 3 years for women 25-69 after sexual activity; mammogram every 2 years for women 50-69; colorectal (FIT) annually for ages 50-69; consider colonoscopy every 10 years.

Childhood immunisation schedule (Singapore): BCG at birth; Hepatitis B at birth, 1, 6 months; DTaP-IPV-Hib at 2, 4, 6, 18 months; MMR at 12 and 15-18 months; varicella at 12-15 months; pneumococcal at 3, 5, 12 months; HPV for females 9-26 years.

Adult vaccinations: influenza annually for ≥65, chronic disease, pregnancy; pneumococcal (PCV13 then PPSV23) for ≥65 or high-risk; Tdap booster every 10 years; zoster vaccine for ≥50.

Chronic kidney disease staging: eGFR G1 ≥90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 <15; albuminuria A1 <3 mg/mmol, A2 3-30, A3 >30; monitor BP, ACEi/ARB, avoid NSAIDs.

Asthma control assessment (GINA): daytime symptoms ≤2/week, no night waking, reliever use ≤2/week, no activity limitation, normal lung function - all indicate controlled asthma.

Cardiovascular risk assessment: use validated charts (e.g., Framingham, SCORE); in Singapore, consider using the Singapore Coronary Risk Calculator; statins recommended if 10-year risk ≥20% or diabetes with additional risk factors.

Medical Registration Act: all doctors must hold valid practising certificate from Singapore Medical Council (SMC); annual renewal; CPD requirements (e.g., 50 CME points per year) must be met.

SMC Ethical Code and Ethical Guidelines (ECEG 2016): core principles - patient welfare, respect for patient autonomy, social justice; mandatory reporting of impairment or misconduct.

Poisons Act and Medicines Act: controlled drugs (e.g., opioids, benzodiazepines) require special record-keeping, secure storage, and prescription restrictions; Misuse of Drugs Regulations apply.

Infectious Diseases Act: mandatory notification of specified diseases (e.g., measles, mumps, rubella, tuberculosis, dengue, chickenpox, hand-foot-mouth disease) to MOH within specified timeframes.

MediShield Life and Integrated Shield Plans: primary care doctors must be aware of claim rules; Community Health Assist Scheme (CHAS) subsidies for chronic conditions and selected screenings.

Personal Data Protection Act (PDPA): patient data must be protected; consent required for collection, use, disclosure; exceptions for emergency care and mandatory reporting.

Telemedicine guidelines (SMC): ensure appropriate modality, patient identity verification, informed consent, documentation, and continuity of care; prescribe only when safe and within competence.

Clinic licensing under Private Hospitals and Medical Clinics Act: premises, equipment, staff qualifications, and record-keeping standards must comply; regular audits.

Informed consent: disclose diagnosis, nature of procedure, risks, benefits, alternatives, and consequences of refusal; document discussion; patient must have capacity and voluntariness.

Breaking bad news (SPIKES): Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary - use to structure difficult conversations.

Medical error disclosure: duty to be open and honest with patients when harm occurs; explain what happened, apologize, outline steps to prevent recurrence; document in notes.

Confidentiality: do not disclose patient information without consent unless required by law (e.g., infectious disease reporting, court order) or in public interest; share only on need-to-know basis.

Prescribing safety: check allergies, interactions, renal/hepatic function, pregnancy status; use clear handwriting or electronic prescribing; avoid abbreviations; provide written instructions.

Hand hygiene: WHO 5 moments - before touching patient, before clean/aseptic procedure, after body fluid exposure, after touching patient, after touching patient surroundings.

Consent for minors: age of consent for medical treatment in Singapore is 18 (per Civil Law Act); under 18, parent/guardian consent generally required, but mature minor doctrine may apply for certain treatments.

Chaperone policy: offer chaperone for intimate examinations; document refusal; chaperone should be same sex if possible; maintain patient dignity.